Provider Demographics
NPI:1275522526
Name:COONROD, RITA ALINE (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:ALINE
Last Name:COONROD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:HOT SULPHUR SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80451-0335
Mailing Address - Country:US
Mailing Address - Phone:970-389-5038
Mailing Address - Fax:
Practice Address - Street 1:145 PARSENN RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:CO
Practice Address - Zip Code:80482-5133
Practice Address - Country:US
Practice Address - Phone:970-726-4299
Practice Address - Fax:970-726-4322
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR33909207Q00000X
CO33909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01339092Medicaid
F96229Medicare UPIN
COCOAAA0597Medicare UPIN
CO01339092Medicaid